Toshiaki Sanada

Risk factors in relation to postoperative complications in patients undergoing esophagectomy or gastrectomy for cancer.

To clarify the risk factors contributing to postoperative complications in the elderly patients (over 70 years) undergoing esophagectomy and/or gastrectomy, 364 patients with primary cancer seen were evaluated. As a result, some characteristic patterns of stress response in the elderly could be detected as follows: the disorders of the vital organs were more important indices for the development of postoperative complications rather than age, and a reduction in the maximum response of the stress hormones to surgical procedures in aged patients was noted; moreover, the functional variability of target organ in the aged group was confirmed. Studies on the hormonal response to surgery suggest that the restriction of fluid replacement is advisable until the third postoperative day, maintaining the host on the dry side, to prevent cardiopulmonary complications. As the nutritional status in the patients with esophageal and gastric cancer goes from bad to worse with the advancing clinical stages, adequate perioperative nutrition is imperative to prevent complications such as anastomotic leakage, wound dehiscence, and/or infections. For the treatment of anastomotic leaks after esophagectomy and esophagogastrectomy, more than 45 kcal/kg/d must be provided, and the serum albumin level must be restored to 3.5 g/dL in order to achieve spontaneous healing of small anastomotic leakages.

Spiral computed tomography for biliary dilatation.

Spiral computed tomography (SCT), which consists of rapid volumetric data acquisition and planar image display, was performed on 12 patients with biliary dilatation after excisional procedure. The technique was evaluated for image quality and impact on clinical practice. All patients safely underwent SCT scanning after intravenous cholangiography (IVC) without any sedations. In 11 of 12 patients reliable biliary images were obtained and three-dimensional (3D) reconstruction images of the biliary system with bilioenteric anastomosis were generally of diagnostic quality even in young children. As a consequence, IVC-SCT technique appears to have the potential for improving the efficacy and safety of diagnostic CT in investigation of the biliary system. In particular, this technique may be useful for detecting bilioenteric anastomotic conditions in follow-up studies of pediatric patients with biliary dilatation.

Pancreatoblastoma managed by pancreatoduodenectomy and extended right lobectomy

We report a case in which a pancreatoblastoma with liver metastasis was successfully resected by pancreatoduodenectomy and extended right lobectomy after effective chemotherapy. The combination of surgery and chemotherapy may be a potentially useful treatment for advanced metastatic pancreatoblastoma.

Anorectal Stenosis in a Neonate: Report of a Case and Review of the Japanese Literature

We report herein the case of an infant with anorectal stenosis successfully treated by staged surgery. At 1 day of age, the anal orifice showed circumferential stenosis located 5 mm from the anal verge and extending into the anal canal for approximately 1 cm; however, no hypertrophic raphe or bucket handle appearance were observed, and no associated anomalies such as a presacral mass or sacral dysgenesis were found. At 2 days of age, the infant underwent a sigmoid colostomy under the diagnosis of low anorectal stenosis, followed by a successful anorectoplasty, performed through a sacroperineal approach when he was 8 months old. An analysis of 13 other cases of anorectal stenosis from the Japanese literature indicates that this type of malformation should be treated by staged surgery, as an initial colostomy in the neonatal period, followed by anorectoplasty through a sacroperineal approach during infancy.

Tissue insulin contents in nesidioblastosis. Report of two cases

We present two cases of nesidioblastosis, a common cause of persistent hypoglycemia in infancy that, if inadequately treated, can lead to mental retardation. Tissue insulin data obtained from both radioimmunoassay and immunohistochemistry are presented. In each case, the insulin content correlated well with the quantity of insulinpositive cells in each portion of the pancreas. However, the insulin content varied from case to case and from portion to portion of the same pancreas. Thus, discrepancies in clinical results in nesidioblastosis may be due to variability of insulin content in the resected pancreas.

Catheter complications of total parenteral nutrition. Therapeutic problems for fungal endophthalmitis.

1986年より1988年までの3年間に当科に入院した消化器外科疾患患者のうち高カロリー輸液施行症例715例を対象として, カテーテル留置に伴う合併症発生頻度を検索し, 同期間中に発生した真菌性眼内炎の4例の経験からその治療上の問題点と対策について検討した.カテ-テル敗血症発生頻度は17.4%であり, カテーテルの先端培養陽性率は55例/152例 (36%), このうち31例, 56%と過半数が真菌陽性例であった.内因性真菌性眼内炎は4例で, その発生率は0.4%であり, カテーテル敗血症例を母集団とした場合の頻度は2.6%となった.内因性真菌性眼内炎では早期診断, 早期治療がその予後を大きく左右するため, カテーテル敗血症を認めた際には, 即時カテーテルを抜去し内因性真菌性眼内炎の発生を念頭において, 眼症状についての十分な問診と眼科専門医による眼底検査を行うべきである.